Respiratory symptoms and outcomes among cigar smokers: findings from the Population Assessment of Tobacco and Health (PATH) study waves 2-5 (2014-2019)

BACKGROUND

The mechanisms by which cigarette smoking increases the risk of respiratory disease have been studied. However, less is known about risks of respiratory symptoms and outcomes associated with smoking cigars, and risks by cigar types have not been previously explored. The aim of this study was to examine associations between cigar use, including traditional cigars, cigarillos, filtered cigars, and dual cigar and cigarette use, and functionally important respiratory symptoms (FIRS), lifetime asthma diagnosis, uncontrolled asthma, and new cases of FIRS.

METHODS

Data from Waves 2-5 (2014-19) of the Population Assessment of Tobacco and Health (PATH) Study, a nationally representative longitudinal study, were analyzed in two ways. For cross-sectional analysis, the analytic sample included adults 18 and older at each wave, resulting in 44,040 observations. Separately, longitudinal analyses were assessed among adults 18 and older at Wave 2, resulting in 7,930 individuals. Both analyses excluded adults with chronic obstructive pulmonary disease (COPD) or non-asthma respiratory disease.

RESULTS

Current established cigarillo smokers had higher odds of having FIRS (Adjusted odds ratio (AOR): 1.72; 95% CI: 1.08, 2.74) compared to never smokers of cigarillos and cigarettes, after adjusting for covariates. Current established filtered cigar smokers had higher odds of asthma diagnosis (AOR: 1.35; 95% CI: 1.10, 1.66) while current established dual smokers of filtered cigars and cigarettes had higher odds of uncontrolled asthma (AOR: 5.13; 95% CI: 1.75, 15.02) compared to never smokers of filtered cigars or cigarettes. Both current established cigar smokers and current established dual smokers of cigarettes and cigars had higher odds of new FIRS compared to never cigar or cigarette smokers (AORs: 1.62; 95% CI: 1.02, 2.60 for exclusive cigars and 2.55; 95% CI 1.57, 4.14 for dual smokers).

CONCLUSIONS

This study provides evidence that cigar smokers or dual smokers of cigars and cigarettes have greater odds of FIRS, asthma, and uncontrolled asthma and that new incidence of FIRS is higher among any cigar smokers compared to never cigar or cigarette smokers. Understanding health impacts associated with cigar use provides information for supporting policy development, as well as for designing clinical interventions focused on smoking cessation for cigars.

Examining Cigar Pack Quantity Purchases by Cigar Type in the United States Between 2014 and 2017

INTRODUCTION

We examined whether the proportion of cigar pack quantity usually purchased differed between 2014 and 2017 in the United States.

METHODS

Data are from waves 1 and 4 of the Population Assessment of Tobacco and Health Study. The proportions of pack quantity purchases between waves for premium cigars, large cigars, cigarillos, and filtered cigars for 10-pack quantities (singles, 2-packs, 3-packs, 4-packs, 5-packs, 6-9-packs, 10-packs, 11--19-packs, 20-packs, ≥21 packs) were compared using Z-tests. We used multivariable linear regressions to examine factors associated with pack quantity.

RESULTS

For premium cigars, most adults purchased singles, with 84.4% in 2014 and 88.7% in 2017. For large cigars, single purchases increased from 46.2% to 62.7% (p < .00001). Two-packs also increased, 3.1% to 10.2% (p < .00001), while 5-packs, 6-9 packs, 10-19-packs, and 20-packs decreased. For cigarillos, singles purchases increased from 51.9% to 57.5% (p = .0002). Two-packs also increased, 8.8% to 19.6% (p < .00001), while 3-packs, 4-packs, 5-packs, and 20-packs decreased. For filtered cigars, the most prevalent pack quantity shifted from 20-packs in 2014 (62.6%) to singles in 2017 (36.7%). Singles, 2-packs, 3-4-packs, and 5-packs increased while 11-19-packs, 20-packs, and ≥21 packs decreased. Days used were positively associated with pack quantity purchase for all cigar types in 2017, while the price was positively associated with premium cigar purchase.

CONCLUSIONS

Between 2014 and 2017, the proportion of consumers who purchased singles remained at over 80% for premium cigars and increased for other cigars. Continued monitoring of use behaviors, including pack quantities by cigar type, is needed as the market and policy landscapes continue shifting.

IMPLICATIONS

Single cigar purchases are prominent across cigar types. Five-packs and 20-packs were the second most common pack quantities across cigar types, with relatively low proportions for other pack quantities. These findings suggest adults consuming premium cigars consistently prefer singles, a pattern that was found across cigar types. However, when considering purchases made online, premium cigars are widely purchased in larger pack quantities. Age and race were associated with purchase for some cigar types at some years, days used were associated with the purchase quantity in 2017 for all cigar types, and price was positively associated across time periods for only premium cigar purchases. Thus, the factors associated with cigar pack quantity purchase remain unclear. As the cigar policy landscape shifts, continued monitoring of the purchase behaviors by cigar type will be important to better inform future cigar policies.

Premium and Non-Premium Cigar Use Among a Nationally Representative Sample of Reproductive Age Women: Findings from the 2010-2019 National Survey on Drug Use and Health

INTRODUCTION

Little is known about cigar use among women of reproductive age, especially potential differences relating to the use of premium versus non-premium cigars.

AIMS AND METHODS

Using 2010-2019 data from the National Survey on Drug Use and Health, rates and trends in premium and non-premium cigar use were determined among women of reproductive age (18-49; n = 5651). Weighted sociodemographic characteristics, substance co-use, patterns of use, and health indicators were compared between women using premium versus non-premium cigars.

RESULTS

Among reproductive-aged women who smoked cigars in the past 30 days, 4.9% reported use of premium cigar brands. The most commonly used premium brands were Romeo y Julieta, Cohiba, and Macanudos. Women who used premium versus non-premium cigars were less likely to identify as non-Hispanic black (16.5% vs. 35.5%), more likely to have household income >$50 000 (54.2% vs. 26.6%), and less likely to report past 30-day marijuana (28.7% vs. 55.7%) or blunt use (26.0% vs. 53.9%; ps < .001). Women who used premium cigars also reported later age of onset of cigar use (24.1 vs. 20.3 years; p < .001) and smoked fewer cigars in the last 30 days (9.8 vs. 2.3 days; p < .001). Trend analysis revealed that although rates of past 30-day premium cigar use remained consistent from 2010 (4.7%) to 2019 (4.9%), prevalence decreased from 6.6% in 2017 to 2.8% in 2018 before increasing to 4.9% in 2019.

CONCLUSIONS

Understanding premium and non-premium cigar use among reproductive-age women, an understudied vulnerable population, will provide critical data to the Food and Drug Administration to inform policy and regulatory decisions.

IMPLICATIONS

The current study revealed prevalence of ~5% premium cigar use among women of reproductive age who smoke cigars, and evidence for consistency in women's rates of premium cigar use across time. Women who used premium versus non-premium cigars were more likely to identify as non-Hispanic white, older, and of higher socioeconomic status were in better health and less likely to co-use cigarettes and marijuana, but more likely to co-use alcohol. Consideration of reproductive age and pregnant women as uniquely vulnerable populations is warranted in the development of regulations regarding premium and non-premium cigars. Comprehensive regulation of cigars (both premium and non-premium) may offer the potential to positively impact women's health.

Patterns of Premium and Nonpremium Cigar Use in the United States: Findings from Wave 6 (2021) of the Population Assessment of Tobacco and Health Study

INTRODUCTION

Understanding the characteristics of premium cigar use patterns is essential for minimizing public health harms. Typically, premium cigars are handmade, larger, more expensive, and without the characterizing flavors that are present in other cigar types: Nonpremium traditional cigars, cigarillos, and filtered cigars.

AIMS AND METHODS

Self-reported brand and price data were used from Wave 6 of the Population Assessment of Tobacco and Health (PATH) Study to define and estimate premium versus nonpremium cigar use among U.S. adults, as well as to explore cigar smoking patterns, purchasing behavior, and reasons for use by cigar type.

RESULTS

In 2021, 0.9% (95% CI = 0.7-1.0) of adults were premium cigar users, compared to 0.4% of nonpremium traditional cigar users (95% CI = 0.3-0.5), 1.1% of cigarillo users (95% CI = 1.0-1.2), and 0.6% filtered cigar users (95% CI = 0.5-0.7). Premium cigar users were overwhelmingly male (97.7%), and 35.8% were aged ≥55 years. The average premium cigar price/stick was $8.67, $5.50-7.00 more than other cigar types. Compared to other cigar types, significantly fewer premium cigar users had a regular brand with a flavor other than tobacco (~15% vs. 38%-53%). Though flavors remained the top reason for premium cigar use, they were less likely to endorse flavors as a reason for use than other cigar users (~40% vs. 68-74%). Premium cigar users had a lower prevalence (aRR: 0.37, 95% CI = 0.25-0.55) of dual use of cigars and cigarettes.

CONCLUSIONS

Although <1% of U.S. adults use premium cigars, their use and purchasing characteristics continue to differ from other cigar types, highlighting the importance of capturing data specific to premium cigar use.

IMPLICATIONS

This manuscript extends previous research from the National Academies of Science, Engineering, and Medicine report, "Premium cigars: Patterns of use, marketing, and health effects" by utilizing the most recent PATH Study data (Wave 6) to examine patterns of cigar use, including purchasing behavior and reasons for use, by cigar type (eg, premium traditional cigars, nonpremium traditional cigars, cigarillos, and filtered cigars). The findings support continued research on patterns of premium cigar use, which differ from use patterns of other cigar types.

Trends in Cigar Sales and Prices, by Product and Flavor Type-the United States, 2016-2020

INTRODUCTION

Cigar smoking has increased in recent decades as the cigar product landscape has diversified. This study assessed trends in US cigar sales during 2016-2020.

AIMS AND METHODS

Unit sales and average unit price for cigars were assessed during January 3, 2016-June 13, 2020, overall and by product and flavor type, for the 48 contiguous US states and D.C. Assessed cigar types were large cigars, little cigars, and cigarillos; assessed flavor types were tobacco/unflavored, candy/sweets, fruit, menthol, alcohol, coffee, other flavors, and no flavor stated. A joinpoint regression model was used to assess the magnitude and significance of sales trends.

RESULTS

During January 3, 2016-June 13, 2020, unit sales of cigarillos increased (average monthly percentage change [AMPC] = 0.7%, p < .001), while unit sales of large cigars (AMPC = -0.8%, p < .001) and little cigars decreased (AMPC = -0.2%, p < .001). The average price of cigarillos gradually decreased since mid-August 2017 (AMPC = -0.1%, p < .001), and the average price of little cigars decreased from mid-June 2016 to mid-June 2019 (AMPC = -0.3%, p < .001). In contrast, the average price of large cigars increased during the entire study period (AMPC = 0.6%, p < .001). Irrespective of cigar type, tobacco-flavored/unflavored products were the most commonly sold cigars during the assessed period; however, sales of other flavors varied by cigar type.

CONCLUSIONS

Cigar sales and price vary by type over time in the United States, including sales of cigarillos (94.2% of unit sales) increasing as their prices have decreased in recent years. Public health strategies are warranted to address the full scope of cigar types being used in the United States.

IMPLICATIONS

Surveillance of cigar sales data, including product characteristics, can provide a timely complement to self-reported survey data of cigar use. This study assessed trends in US cigar sales during 2016-2020, including by product and flavor type. The findings indicate that sales of cigarillos, which comprise most cigar sales in the United States during the assessed period, increased as their prices decreased. Sales of certain flavors, such as candy/sweet cigarillos and coffee large cigars, increased significantly. These findings reinforce the importance of evidence-based strategies, including increasing price and restricting flavors, to reduce the affordability and consumption of cigars in the United States.

COMPARISON OF PREVALENCE OF TOBACCO USE AMONG YOUNG PEOPLE IN DIFFERENT COUNTRIES

OBJECTIVE

The aim: The prevalence analysis of three ways of tobacco use among young adults: traditional (smoking of cigarillos or cigars) and alternative (hookah smoking and use of E-cigarettes) as well as the development of ways of tobacco smoking prevention.

PATIENTS AND METHODS

Materials and methods: Cross-section anonymous survey among young adults 18-44 years of age (n=410) has been conducted. The obtained results were compared with the data of the similar studies from different countries. The statistical methods (analysis of the mean and relative values), structural and logical analysis and systemic approach.

RESULTS

Results: Among those who were interviewed, aged 18-44 years, there are 24.15±2.11 % of respondents - hookah smokers, 9.02±1.42 % persons prefer the traditional method of tobacco use (smoking of cigarillos or cigars), while 6.34±1.20 % ones use E-cigarettes. Such forms of smoking are more common among males. The smokers of cigarillos, cigars and hookahs have appreciated their high availability when buying - 9 (7;10) points out of 10 possible. The study has found that 11.54±1.58 % of smokers of E-cigarettes and 8.08±1.35 % of hookah smokers consider them safe types of smoking and harmless to their health.

CONCLUSION

Conclusions: The prevention methods of smoking prevalence among young people must be based on the tougher rules of tobacco market and latest devices for smoking at the legislative level.

Retail outlets prompt associative memories linked to the repeated use of nicotine and tobacco products among alternative high school students in California

Numerous studies have examined how youth are influenced by the presence of tobacco retail outlets that use point-of-sale marketing tactics to promote nicotine and tobacco products. The current investigation extends this research by assessing whether tobacco retail outlets function as environmental cues that prompt associative memories linked to the repeated use of cigarettes, electronic cigarettes, and cigars. Students (N = 1060) from 29 alternative high schools in California were recruited into a three-year cohort study. A repeated measures latent profile analysis was conducted to identify latent subgroups of students. Analyses suggested the presence of one subgroup of students that did not use nicotine and tobacco products and five subgroups of students that used multiple products. A multinomial logistic regression revealed that images of gas stations, convenience stores, and liquor stores presented in the first year of the study prompted spontaneous associations in memory that increased the odds a student would belong to one of the five subgroups that repeatedly used nicotine and tobacco products over a three-year period. These findings suggest that tobacco retail outlets may act as environmental cues that prompt the use of addictive products among at-risk youth. Policymakers should consider implementing strategies that reduce the potency and prevalence of these cues.

Evaluating the predictive value of measures of susceptibility to tobacco and alternative tobacco products

BACKGROUND

The "cigarette susceptibility index" has been adapted for other products, yet, the validity of these adapted measures-particularly among youth who have used other tobacco products-has not been evaluated.

METHODS

We used prospective data from the Southern California Children's Health Study to evaluate the association of questionnaire measures assessing susceptibility to e-cigarette, cigarette, hookah and cigar/cigarillo/little cigar use at wave 1 (W1; 11th/12th grade) with subsequent initiation between W1 and W2 (16 months later, N = 1453). We additionally examined whether each effect estimate differed by use of other tobacco products at W1.

RESULTS

Odds ratios, attributable risk%, and risk differences for product initiation among susceptible vs. non-susceptible youth were consistently higher among never users of any tobacco product than among youth with any tobacco use history. For example, susceptible (vs. non-susceptible) youth with no prior tobacco use had 3.64 times the odds of subsequent initiation of e-cigarettes (95%CI:2.61,5.09), while among users of another product, susceptible (vs. non-susceptible) youth had 1.95 times the odds of e-cigarette initiation (95%CI:0.98,3.89; p-interaction = 0.016). 60.4% of e-cigarette initiation among never users of any product could be attributed to susceptibility, compared to 19.8% among users of another product. The e-cigarette absolute risk difference between susceptible and non-susceptible youth was 21.9%(15.2,28.6) for never users, vs. 15.4%(0.2,30.7) for users of another product.

CONCLUSION

Tobacco product-specific susceptibility associations with initiation of use at W2 were markedly attenuated among prior users of other products, demonstrating reduced utility for these measures among subjects using other products.

Systematic review of cigars, cigarillos, and little cigars among adolescents: Setting research agenda to inform tobacco control policy

INTRODUCTION

We conducted a systematic review of the literature on cigar research on youth to identify potential future research agenda to generate evidence to inform cigar regulations to prevent cigar use among youth.

METHODS

We searched articles on Medline, EMBASE, and PsycINFO in April 2017 to identify articles relevant to cigars and adolescents. Two independent coders examined 48 articles to determine eligibility: (1) published between 2000-April 2017; (2) published in English; (3) conducted in the United States; (4) published in a peer-review journal; (5) examined cigars, cigarillos, or little cigars; (6) included youth (12-18 years old); and (7) included empirical data. Three independent coders reviewed the included articles (n = 48) to identify whether the studies addressed FDA's Research Priorities.

RESULTS

The studies addressed FDA's Research Priorities of "behavior" (n = 48), "communications" (n = 4), "marketing influences" (n = 1), and "impact analysis" (n = 1). Studies on "behavior" underscored the need for improvements in measurement, such as using brand names and distinguishing cigar products. The review revealed the need for restrictions on cigar flavors, development of media campaigns and interventions, increasing the cost (via taxation), and evaluating the impact of cigar policies.

CONCLUSIONS

The studies mostly focused on surveillance of behaviors and use patterns, which revealed cigar specific issues to address in policies to decrease cigar use among youth. The lack of studies addressing other FDA's research priorities highlighted the critical need for future studies that inform prevention of youth cigar use.

Correlates of cigarette and alternative tobacco product use among young tobacco users experiencing homelessness

INTRODUCTION

Most young people experiencing homelessness smoke cigarettes, but little is known about use of alternative tobacco products (ATPs) such as e-cigarettes or other electronic nicotine delivery systems (ENDS) and little cigars/cigarillos (LCCs). This study examines past month use and correlates of cigarettes and ATP among young tobacco users experiencing homelessness.

METHODS

We surveyed a probability sample of N = 469 unaccompanied homeless 13-25 year olds (mean age = 22; 71% male), who reported past month use of any type of tobacco product, from 25 service and street sites in Los Angeles County.

RESULTS

Nearly all (90%) participants reported smoking regular cigarettes, and 78% reported using at least one tobacco product other than regular cigarettes. The most commonly used of these other products was natural cigarettes (55%), followed by LCCs (43%), ENDS (34%), cigars (31%), hookah (14%), chewing tobacco (7%), and snus (5%). Multivariable models indicated that correlates of past month use differed by product, but included sociodemographic characteristics, homelessness severity, depression, exposure to other people who used the product, and product perceptions (e.g., relative access, cost, and harm compared to cigarettes).

CONCLUSION

Use of cigarettes and ATPs are both widespread among young homeless tobacco users, suggesting that efforts to reduce tobacco use in this population should have a broad focus that includes a variety of products. The effectiveness of these efforts may be enhanced by addressing their considerable exposure to other tobacco users, as well as their perceptions of certain products as being less harmful or more cost-effective options than regular cigarettes.

Differences among cigarette-only smokers compared to dual users of cigarettes and little cigars/cigarillos in the criminal justice population

INTRODUCTION

The FDA has restrictions on cigarettes; however, little cigars and cigarillos (LCCs) remain largely absent from these regulations. Due to their low prices and flavoring, many engage in dual use of both LCCs and cigarettes. Dual use is particularly prevalent among low income racial/ethnic minority groups. The purpose of this study was to (U.S. Department of Health and Human Services, 2014) conduct an exploratory examination among cigarette users compared to dual users on smoking characteristics; and (Centers for Disease Control and Prevention, 2016) to examine racial differences (White and Black) among cigarette users compared to dual users.

METHODS

Participants (N = 500) were recruited from community corrections (i.e., parole/probation) and categorized as either cigarette-only (66.4%) or dual users (33.6%) if they used little cigars or cigarillos over a one-year period during a smoking cessation clinical trial.

RESULTS

Dual users were more likely to be younger, Black, males with lower educational attainment compared to cigarette-only smokers. Smokers with increased nicotine dependence were 17% more likely to be cigarette-only smokers compared to dual users. Racial differences revealed that White/cigarette-only smokers were more likely to report non-menthol use and higher cigarette consumption at the end of treatment compared to Black/cigarette-only or Black/dual users.

CONCLUSIONS

This study contributes to our understanding of dual use among a disenfranchised group of smokers. Overall, dual users were more likely to be younger, Black, and male with lower reported nicotine dependence compared to cigarette-only users. Racial differences revealed that non-menthol smokers as well as smokers with greater cigarettes smoked at the end of treatment were more likely White/cigarette-only smokers.

US Adult Cigar Smoking Patterns, Purchasing Behaviors, and Reasons for Use According to Cigar Type: Findings From the Population Assessment of Tobacco and Health (PATH) Study, 2013-2014

Introduction

The US cigar market is diverse, yet until recently most research studies and tobacco surveillance systems have not reported behavioral and related outcomes by cigar type.

Methods

The 2013-2014 Population Assessment of Tobacco and Health Study collected data separately for filtered cigars (FCs), cigarillos, and traditional cigars, which were further distinguished as premium or nonpremium. Descriptive statistics for adult established current smokers of each cigar type and cigarettes were calculated for demographic characteristics, tobacco use patterns, purchasing behaviors and reasons for use. Adjusted prevalence ratios (APRs) using a marginal predictions approach with logistic regression assessed correlates of dual cigar and cigarette smoking.

Results

Age, sex, race/ethnicity, education level, and poverty status of smokers varied according to cigar type. Daily cigar smoking prevalence and number of cigars smoked per day were higher for FCs (37.3%; median: 1.6 cigars/day, respectively), than all other cigar types (6.7%-25.3%, all p < .01; 0.1-0.4 cigars/day, all p < .01, respectively); daily smoking and cigars per day were similar for nonpremium cigars and cigarillos (p = .11; p = .33, respectively). Cigarette smoking was twice as common among smokers of nonpremium cigars, cigarillos, and FCs (58.0%-66.0%) than among premium cigars (29.9%). Among current cigar smokers, FC smokers (APR = 1.23, 95% confidence interval [CI] = 1.09-1.39), other tobacco product users (APR = 1.27, 95% CI = 1.15-1.41), and those with a GED/high school diploma or less (APR = 1.20, 95% CI = 1.09-1.33) were more likely to also smoke cigarettes.

Conclusion

User characteristics, cigar smoking patterns, and dual smoking with cigarettes varied by cigar type highlighting the importance of adequately describing the cigar type studied and, where appropriate, differentiating results by cigar type.

Implications

Despite the diversity of the cigar market place, historically many research studies and tobacco surveillance systems have treated cigars as a single product type. This study describes similarities and differences in the user characteristics, tobacco use patterns, and purchasing behaviors of premium, nonpremium, cigarillo, and filtered cigar smokers. To enhance tobacco regulatory science, sufficient descriptions of the cigar type(s) studied and, where appropriate, differentiation of the particular cigar type(s) studied should be undertaken to improve the interpretation of study findings, understanding of cigar use patterns and related behaviors and future approaches to reducing cigar-attributable morbidity and mortality.

Flavored Tobacco Use Among U.S. Adults by Age Group: 2013-2014

OBJECTIVE

This study sought to assess patterns of flavored tobacco product (FTP) use and their associations with (1) susceptibility to smoke cigarettes among young adults aged 18-29 who have never smoked; (2) quit attempts in the past 12 months among current cigarette users by age group (18-29, 30-49, and 50+).

METHODS

We used the 2013-2014 National Adult Tobacco Survey (n = 75,233) to estimate the prevalence of single-, dual-, and poly-use of FTP (menthol cigarettes, e-cigarettes, cigars, regular pipes/hookahs, and smokeless). Logistic regression models were performed to examine the associations between FTP use and smoking behaviors.

RESULTS

Among current tobacco users, young adults aged 18-29 (72.7%) had a higher prevalence of FTP use than other age groups (30-49: 51.7% and 50+: 37.9%). For FTP use within each age group, dual- and poly-FTP use was most popular among young adults aged 18-29 and menthol cigarette use was most popular among older adults aged 50+. Compared with not using any tobacco products, FTP use was associated with higher odds of susceptibility to cigarette smoking among young adult never smokers (single FTP use: aOR =5.5, CI: 4.2-7.3; dual/poly FTP use: aOR =10.7, CI: 6.2-18.4). FTP use was not associated with quit attempts among current cigarettes users aged under 50, while dual/poly-FTP use was associated with higher odds of quit attempts among current cigarette users aged 50 + (aOR =1.7, CI: 1.2-2.4).

CONCLUSIONS

This study shows the heterogeneity of FTP use among adults by age group and demonstrates its associations with susceptibility to cigarette smoking among young adult never smokers.

Posttraumatic stress disorder and tobacco use: A systematic review and meta-analysis

Posttraumatic stress disorder (PTSD) and tobacco use are prevalent conditions that co-occur at striking rates in the US. Previous reviews examined prevalence and factors associated with cigarette smoking among individuals with PTSD but have not been summarized since 2007. Moreover, none explored rates and factors associated with the use of other tobacco products. This study aimed to systematically review the most recent literature examining the comorbidity of PTSD and tobacco use to provide prevalence rates, as well as summarize the literature exploring other factors associated with tobacco use among individuals with PTSD. Studies were identified using a systematic search of keywords related to tobacco use and PTSD within the following databases: PubMed, PsycINFO, Web of Knowledge, CINAHL, PsycARTICLES, and Cochrane Clinical Trials Library. The studies included in this review (N = 66) showed that the prevalence of current use of tobacco products in individuals with PTSD was 24.0% and the rate of PTSD among users of tobacco products was 20.2%. Additionally, results demonstrated that individuals with PTSD present with high levels of nicotine dependence and heavy use of tobacco products, as well as underscore the importance of negative emotional states as a contributing factor to tobacco use among individuals with PTSD. It is imperative that future studies continue monitoring tobacco use among individuals with PTSD while also assessing factors identified as having a prominent role in tobacco use among individuals with PTSD. These findings also demonstrate the need for more innovative approaches to reduce the pervasive tobacco use among individuals with PTSD.

Body mass index and tobacco-product use among U.S. youth: Findings from wave 1 (2013-2014) of the Population Assessment of Tobacco and Health (PATH) Study

INTRODUCTION

Tobacco and obesity are leading contributors to mortality in the United States. Due to emerging changes in youth tobacco use, further examination of co-occurrence of these issues is warranted.

METHODS

This study examined associations between body mass index (BMI) and tobacco-product use and whether these varied by gender in a nationally representative sample of 12,416 Wave 1 (2013-2014) U.S. youth (12-17 years) from the Population Assessment of Tobacco and Health Study. Multivariable logistic regression analyses examined the odds of past 30-day tobacco-product use according to BMI. BMI was analyzed categorically using the Centers for Disease Control and Prevention (CDC) BMI-for-age weight status categories (underweight/healthy weight, overweight, and obese) and as a continuous variable.

RESULTS

Youth classified as overweight or obese were not more likely to use any tobacco, cigarettes, e-cigarettes, any cigar, or hookah. However, youth who were obese were more likely to use smokeless tobacco (Adjusted Odds Ratio (AOR) = 1.68, 95% Confidence Interval (CI): 1.01, 2.81). There were no significant gender interactions for these associations. When BMI was analyzed continuously, a 5-unit and 10-unit increase was significantly associated with using any tobacco, cigarettes, any cigar, and smokeless tobacco. This linear association was supported by similar results for a log-transformed BMI variable.

CONCLUSIONS

Findings suggest a continuum between weight increase and tobacco-product use among American youth. Clinicians should consider screening for tobacco use among youth who gain weight within any weight class, not just those considered overweight or obese.

E-cigarette marketing exposure and combustible tobacco use among adolescents in the United States

E-cigarette advertising has been shown to be associated with use of e-cigarettes, but its association with tobacco use has not been studied. Therefore, we examined the association between e-cigarettes advertisement and tobacco use. Data from nationally representative 22,007 middle and high school students (grades 6-12) were used to conduct the analysis. Logistic regression models estimated the adjusted odds ratios (AOR) of ever and current use of cigarette, hookah, cigar, and polytobacco use. Odds ratios were weighted and adjusted for study design, non-response rates, school level, gender, race/ethnicity, e-cigarette use, and smoking at home. E-cigarette marketing exposure was significantly associated with ever use of cigarettes (AOR: 1.3, 95% CI: 1.1-1.5), hookah (AOR: 1.4, 95% CI: 1.2-1.7), cigars (AOR: 1.5, 95% CI: 1.4-1.6), and polytobacco (AOR: 1.7, 95% CI: 1.5-1.8). Likewise, E-cigarette marketing exposure was significantly associated with current use of cigarettes (AOR: 1.3, 95% CI: 1.1-1.6), hookah (AOR: 1.3, 95% CI: 1.03-1.7), cigars (AOR: 1.3, 95% CI: 1.1-1.6), and polytobacco use (AOR: 1.8, 95% CI: 1.5-2.1). The results suggest that e-cigarette advertisement is associated with use of cigarettes, hookah, cigars, and polytobacco products. These results add to the evidence about the risks of e-cigarette marketing and highlight the need for stricter regulation of e-cigarette advertisements.

The association between indoor smoke-free home rules and the use of cigar and smokeless tobacco: A longitudinal study

INTRODUCTION

The existence of an indoor smoke-free home rule is associated with lower use of cigar and smokeless tobacco. This study aims to use a longitudinal sample to examine the association between smoke-free home rules and the cessation and uptake of these two types of tobacco products.

METHOD

The Tobacco Use Supplement of the Current Population Survey surveyed 28,153 adults in May 2010 and then followed them up 12months later. Data from these two surveys and multiple logistic regressions were used to examine the association between overtime smoke-free home rule status and the use of cigar and smokeless tobacco.

RESULTS

Among respondents who used cigar in 2010, having an indoor smoke-free home rules consistently (AOR=2.41, 95% CI=1.52-3.83) and adopting one during the 12-month period (AOR=1.92, 95% CI=1.01-3.68) increased the likelihood of not using cigar in 2011, compared to not having or forgoing a home rule over time. Among adults who had never used cigar by 2010, those having a rule consistently (AOR=0.47, 95% CI=0.38-0.71) were less likely to initiate cigar use. Having a smoke-free home rule consistently was also associated with lower likelihood of start using smokeless tobacco (AOR=0.52, 95% CI=0.35-0.78). Nevertheless, there is no evidence indicating that the adoption of a rule is correlated with the cessation of smokeless tobacco.

CONCLUSION

The establishment of indoor smoke-free home rules may help reduce cigar use and prevent the uptake of cigar and smokeless tobacco. Such findings call for research using experimental design to further examine the impact of home rules on the use of cigar and smokeless tobacco.

Effectiveness of a small cash incentive on abstinence and use of cessation aids for adult smokers: A randomized controlled trial

BACKGROUND

Large amount of financial incentive was effective to increase tobacco abstinence, but the effect of small amount is unknown.

PURPOSE

We evaluated if a small amount of cash incentive (HK$500/US$64) increased abstinence, quit attempt, and use of cessation aids.

METHODS

A three-armed, block randomized controlled trial recruited 1143 adult daily smokers who participated in the Hong Kong "Quit to Win" Contest. Biochemically validated quitters of the early-informed (n=379, notified about the incentive at 1-week and 1-month follow-up) and the late-informed incentive group (n=385, notified at 3-month follow-up) received the incentive at 3months. The validated quitters of the control group (n=379) received the incentive at 6months without prior notification. All subjects received brief advice, a self-help education card and a 12-page booklet. The outcomes were self-reported 7-day point prevalence of abstinence, quit attempt (intentional abstinence for at least 24h) and use of cessation aids at 3-month follow-up.

RESULTS

By intention-to-treat, the early-informed group at 3-month follow-up reported a higher rate of quit attempt (no smoking for at least 24h) than the other 2 groups (44.1% vs. 37.4%, Odds ratio (OR)=1.32, 95% CI 1.03-1.69, p=0.03), but they had similar abstinence (9.2% vs. 9.7%, OR=0.95, 95% CI 0.62, 1.45). The early- and late-informed group showed similar quitting outcomes. The early-informed group reported more quit attempts by reading self-help materials than the other 2 groups (31.4% vs. 25.3%, OR=1.56, 95% CI 1.12-2.18, p<0.01).

CONCLUSIONS

The small cash incentive with early notification increased quit attempt by "self-directed help" but not abstinence. Future financial incentive-based programmes with a larger incentive, accessible quitting resources and encouragement of using existing smoking cessation services are needed.